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A ganglion is a lump of jelly-like material with a lining. A theory about the origin of ganglions is that the thick fluid from a joint becomes trapped in the tissue under the skin. This condition may be related to repetitive activity / use.
Common sites for ganglions include the back of the wrist, the front of the wrist, the palm of the hand (in relation to a flexor tendon) and the base of the fingernail (also known as mucous cyst).
Ganglions are not usually painful, however If one bursts and gets infected, the infection can travel to the underlying joint, and would need to be treated with antibiotics.

An ultrasound can define the size and extent of the ganglion. An X-Ray is also a useful investigation to check for arthritis in the underlying joint.

An incision is made to expose the ganglion, to remove the lining, and to track the stalk to the underlying joint.
Mucous cysts related to the nail are usually removed with the overlying skin. If there is a shortage of skin for wound closure, a local flap would be required. The operation can be performed under General Anaesthetic, and under tourniquet as a day procedure.

The wound is dressed and a splint is applied to immobilise the joint for about 10 days. The patient is instructed to elevate the hand in a sling or on pillows for a few days.
A plastic bag is used to protect the dressing for showers. Some bruising is normal and sutures are normally removed after 2 to 3 weeks.
There is a recurrence rate of about 10% for ganglions at the same site. This is regarded as being due to potential underlying pathology such as arthritis or perhaps that a repetitive activity has continued.

Image by Daniele Levis Pelusi

The Risks

Early sequelae include bleeding, wound infection, swelling and stiffness, abnormal scarring, slow healing, wound dehiscence, damage to a nerve, persistent numbness, and complex regional hand syndrome. Later complications include prolonged swelling and stiffness, complex regional hand syndrome, and recurrence.

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